title: Evidence for cognitive-behavioral strategies improving dyspnea and related distress in COPD.
abstract: BACKGROUND
  Dyspnea is a complex, prevalent, and distressing symptom of chronic obstructive pulmonary disease (COPD) associated with decreased quality of life, significant disability, and increased mortality. It is a major reason for referral to pulmonary rehabilitation.
  
  
  METHODS
  We reviewed 23 COPD studies to examine the evidence for the effectiveness of cognitive-behavioral strategies for relieving dyspnea in COPD.
  
  
  RESULTS
  Preliminary evidence from randomized controlled trials exists to support cognitive- behavioral strategies, used with or without exercise, for relieving sensory and affective components of dyspnea in COPD. Small to moderate treatment effects for relieving dyspnea were noted for psychotherapy (effect size [ES] = 0.08-0.25 for intensity; 0.26-0.65 for mastery) and distractive auditory stimuli (ES = 0.08-0.33 for intensity; 0.09 to -0.61 for functional burden). Small to large dyspnea improvements resulted from yoga (ES = 0.2-1.21 for intensity; 0.67 for distress; 0.07 for mastery; and -8.37 for functional burden); dyspnea self-management education with exercise (ES = -0.14 to -1.15 for intensity; -0.62 to -0.69 for distress; 1.04 for mastery; 0.14-0.35 for self-efficacy); and slow-breathing exercises (ES = -0.34 to -0.83 for intensity; -0.61 to -0.80 for distress; and 0.62 for self-efficacy). Cognitive-behavioral interventions may relieve dyspnea in COPD by (1) decreasing sympathetic nerve activity, dynamic hyperinflation, and comorbid anxiety, and (2) promoting arterial oxygen saturation, myelinated vagus nerve activity, a greater exercise training effect, and neuroplasticity.
  
  
  CONCLUSIONS
  While evidence is increasing, additional randomized controlled trials are needed to evaluate the effectiveness of psychosocial and self-management interventions in relieving dyspnea, in order to make them more available to patients and to endorse them in official COPD, dyspnea, and pulmonary rehabilitation practice guidelines. By relieving dyspnea and related anxiety, such interventions may promote adherence to exercise programs and adaptive lifestyle change.
authors.affiliation: Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Norweg
authors.forename: Eileen G
authors.initials: EG
authors.lastname: Collins
mesh_terms: D001945:Breathing Exercises; D015928:Cognitive Behavioral Therapy; D017281:Cost of Illness; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D019122:Meditation; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care; D016896:Treatment Outcome; D015013:Yoga
keywords: anxiety; chronic obstructive pulmonary disease; distractive auditory stimuli; dyspnea; self-management; slow breathing